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Organization

WANSOM MEDICAL CENTER, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHATE WANSOM M.D. (PRESIDENT)
(734) 242-3060
Entity
Organization

Contact information

Practice address
1492 N MONROE ST, MONROE, MI 48162-4210
(734) 242-3060
(734) 242-3062
Mailing address
1492 N MONROE ST, MONROE, MI 48162-4210
(734) 242-3060
(734) 242-3062

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301038906
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0580012
BCBS
MI
05
1395936
MI
Enumeration date
07/22/2008
Last updated
07/22/2008
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